Office of Licensure and Certification. Feeding/hydration Assistant Training Program

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1 Feeding/hydration Assistant Training Program Introduction It has been determined that residents without complicated feeding problems receive little or no assistance at mealtimes with eating or drinking, while the nursing staff focuses on assisting residents with complicated feeding problems. In order to address this issue, the Center for Medicare and Medicaid Services (CMS) has developed requirements for single-task workers, i.e., feeding/hydration assistants 1, in long-term care facilities. The program is being extended to include all nursing facilities in Virginia, whether federally certified or not. The purpose of this program is to ensure that residents needing only encouragement, minimal assistance, or non-medical supervision, are assisted with eating and drinking as needed. Feeding/ hydration assistants are intended to be adjuncts to, but not replacements for, certified nursing assistants. 2 Therefore, feeding/hydration assistants cannot assist with complicated feeding cases such as recurrent lung aspirations, difficulty swallowing, or with tube or parenteral/iv feedings. Feeding/hydration assistants cannot replace existing licensed or certified staff and cannot be counted toward meeting or complying with any requirements for nursing care staff and functions of a facility, including any minimum nursing staffing requirement imposed under section 1819 or 1919 of the Social Security Act (42 U.S.C. 1395i-3, 1396r). Resident selection to receive assistance from feeding/hydration assistants shall be based on the charge nurse s assessment, the resident s most recent assessment, and the resident s plan of care. To ensure consistency in the training of feeding/hydration assistants, training criteria have been identified. Administrators must ensure that their feeding/hydration assistants meet the requirements of the established criteria. The burden of proof is on the facility to ensure that the program addresses all the requirements of the program and that any feeding/ hydration assistant is properly trained. 1 Volunteers, who are usually family members, may also feed residents because the law and regulations exclude volunteers from the definition of certified nurse aides. Volunteers are exempt from the training requirements, however it is recommended that volunteers participate in training as part of their orientation. 2 This allows facilities to train other facility employees as feeding assistants so that available staff can feed residents at mealtimes. 1

2 Definitions Covered task means feeding and/or hydration. The term does not include (i) administrating medication; (ii) providing direct medical care, including taking vital signs, skin or wound care; or (iii) performing range of motion or other therapeutic exercises with residents. Feeding/hydration assistant means an individual who has successfully completed an approved feeding/hydration training course and is paid by a facility to feed residents, or who is used under an arrangement with another agency or organization and meets the criteria contained herein. Feeding/hydration assistants cannot perform any other nursing or nursing-related tasks. Resident calling system means, in addition to the standard hard wired call system, other means by which a paid feeding assistant can achieve timely notification of a supervisory nurse. General Rules A. A feeding/hydration assistant may perform a covered task only for those residents who, based on their latest assessment and care plan: Need assistance with eating and drinking and Do not have a clinical condition that requires the assistance of a registered nurse, licensed practical nurse, or CNA with eating and drinking as documented in the resident s written plan of care or the comprehensive assessment of the resident s functional capacity. B. A feeding/hydration assistant must successfully complete a minimum of 8 hours of approved training and may perform a covered task only under the supervision of a registered nurse or licensed practical nurse, licensed by the Board of Nursing, who is available to provide assistance to the feeding/hydration assistant if necessary. C. Prior to participating in the program, a facility must submit to the OLC its training program based on the criteria included under Feeding/hydration Assistant Training Requirements in this guideline. Note: Administrators must complete the attached form in its entirety and submit it along with their complete feeding/hydration program to: Training Division 9960 Mayland Drive, Ste. 401 Richmond, VA Facilities may not begin training or using trained assistants until they have received written notice from the OLC. 2

3 D. The facility must maintain a record of all individuals successfully completing the feeding/hydration training course with its other in-service training records. Confirmation of successful completion of the course shall be maintained in the feeding/hydration assistant s personnel folder. E. Facilities must report all incidents of any feeding/hydration assistant that has been found to abuse or neglect a resident, or misappropriate resident property. F. Feeding/hydration assistants cannot be counted toward meeting or complying with any requirement for nursing care staff and functions of a facility, including any minimum nurse staffing requirements. Periodically, facilities will be required to submit to the OLC data regarding the performance on covered tasks by the feeding/hydration assistants in the format and at the times requested by the OLC. Such requests may include, but are not limited to: 1. The number of residents identified as benefiting from the feeding/hydration assistance program; 2. The number of feeding/hydration assistants trained and routinely utilized by the facility to assist identified residents. G. A facility shall notify the OLC 30 working days in advance of any changes being made to their training program. H. Feeding/hydration assistant training records may be shared between facilities in the case of qualified assistants changing employment. Feeding/hydration Assistant Training Requirements A. The feeding/hydration assistant training program shall ensure that feeding assistants have competent knowledge to assist with feeding and hydration. The program shall address, but is not limited to, the following criteria: 1. Feeding techniques and assistance with eating and drinking; 2. Communication and interpersonal skills including appropriate responses to resident behavior; 3. The importance of good nutrition and hydration, including familiarity with signs of malnutrition and dehydration; 4. Recognizing changes in residents that are inconsistent with their normal behavior and the importance of reporting those changes to the supervisory nurse; 5. An overview of the aging and disease process as it relates to nutrition and hydration; 6. Appropriately responding to emergencies by: (i) utilizing resident calling systems to notify the supervising nurse who may not be in the room but is in the building, (ii) 3

4 performing the Heimlich maneuver, and (iii) recognizing other health emergencies; 7. Infection control and universal precautions to prevent the spread of communicable diseases and food borne illnesses; and 8. Resident s rights. In addition, it is recommended that training courses include return demonstrations of feeding/hydration using fellow trainees. It is also recommended that assistants pass a competency evaluation prior to assisting residents with a covered task. It is expected that facilities participating in this program will exceed the required minimum criteria in order to assure the health and safety of all its residents. 4

5 Virginia Department of Health Application for Paid Feeding/Hydration Assistant Training Program Facility Name: Date Submitted: Address: Complete this form in its entirety and send it along with the complete feeding/hydration training program to: Training Division Virginia Department of Health 9960 Mayland Drive, Ste. 401 Richmond, VA Content of Training Program Feeding techniques Communication and interpersonal skills Good nutrition Overview of aging process Signs of dehydration and malnutrition Types of dietary restrictions Recognizing and reporting inconsistencies in resident behavior Emergency procedures Use of the Heimlich maneuver Alerting licensed staff to other health emergencies Infection control and universal precautions Resident rights Other: Location of Element in the Program Content (page, chapter, etc.) Instructor(s) Responsible for Teaching Content I certify that this training program meets the requirements for assuring feeding and hydration assistant are qualified to assist identified residents. Signature of Facility Administrator Date OLC - Approval: